gms | German Medical Science

Objective: In the 1970s hypothalamotomies had been performed in some clinical centers in Germany and Slovakia for the treatment of deviant sexual behaviour. Surgery had been performed because of repeated rape on women and/or pedophilic behavior. Due to the severe psychological strain and the looming imprisonment the patients either wished to be operated on or were given the chance to suspend the prison time. At the time of intervention imaging was done by ventriculography so the lesion could not be verified post intervention.

Method: We were able to locate 8 patients operated in 1970-ies. Five patients agreed to MR-imaging (1.5 Tesla Siemens, T1-weighted mpr, 1 mm voxel size) to determine the location and extent of the unilateral lesion in the hypothalamus. In addition, we performed a voluntary open interview. Based on the mental health data collected at the time of the operation, the Institute for Sex Research and Forensic Psychiatry at the University of Hamburg performed a re-evaluation of the archival-chart material in order to verify if from today’s perspective the sexual deviance would still be classified as a mental disorder, namely a paraphilia.

Results: The reassessment of the psychiatric data showed that 3 of the 5 patients patients were suffering from pedophilic exhibitionism, one of sexual sadism disorder and one from hypersexual urges. The long-term clinical outcome of all 28 patients has been described in detail elsewhere. To our knowledge none of the here presented 5 patients was again criminally prosecuted after the performed surgery up until today. Through open interview we learned that 3 of the 5 patients were married and 2 of them had children. All of them had been constantly employed or freelancers. All 5 patients seemed to have well reintegrated socially. 4 gained weight after the surgery showing a BMI above average. The MRI in all of the 5 patients revealed, beside the clearly visible access path, only a very small lesion in the unilateral anterior hypothalamus for which only indirect signs have been found such as an asymmetric widening of the third ventricle on one side.

Conclusions: Lesion in the anterior hypothalamus placed several decades ago for treating deviant sexual behavior have been re-examined here for the first time by using modern MR-imaging. The ethical and sociocultural implications of these procedures need to be reevaluated from a current point of view.